Hospital Medicine

Physicians writing on KevinMD about hospital practice: employment by health systems and corporate owners, hospital closures after debt-financed acquisition, productivity quotas, the electronic record as hospitalists live with it, from alert fatigue to copy-and-paste, the errors hospitals count and physicians remember, and the nurses physicians work beside. Four maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words, The electronic health record: what physicians say, in their own words, Medical errors: what physicians say, in their own words, and Nursing: what nurses and physicians say, in their own words.

How can we ensure medical leadership includes more women?

Sasha K. Shillcutt, MD

Physician

August 16, 2017

I read something recently that shocked me. Despite working in health care for 15 years, I had no idea that nearly 80 percent of the U.S. health care workforce is comprised of women (according to the Bureau of Statistics.)

I did know, however, that women make up less than 20 percent of executive boards and less than 40 percent of middle management in health care. Those that do exist in the …

We must make the word “diagnostician” the most prestigious term in medicine

Robert Centor, MD

Conditions and Diseases

August 16, 2017

The Society to Improve Diagnosis in Medicine has on its website this quote:

1 in 10 diagnoses are incorrect.
Diagnostic error accounts for 40,000-80,000 U.S. deaths annually — somewhere between breast cancer and diabetes.
Chances are, we will all experience diagnostic error in our lifetime.

The current focus on diagnostic error raises an interesting question: Is this a larger problem in 2017 than in the 1970s and 1980s?

In this post, I …

To those who want government-run health care: Be careful what you wish for

Suneel Dhand, MD

Health Policy

August 15, 2017

“Hello Dr. Payne, thanks for calling back, there’s a consult I’d like you to see.”

“What’s going on?”

“Well there’s a patient up on 7 East who …”

“Wait a minute. 7 East … isn’t there some other specialist covering there?”

“No Dr. Payne, the schedule says you on Wednesdays.”

“Oh, I’ll check that.”

“OK, Dr. Payne, well we have this 72-year old, Mrs. Jones, who originally got admitted with pneumonia. She now has unusual inflammatory …

White nationalists are marching through my town

Taison Bell, MD

Physician

August 14, 2017

I spent the week in meetings discussing logistics and hospital preparations for the alt-right’s “Unite the Right” rally to be held this weekend in my hometown of Charlottesville, VA. We discussed the likely injuries that would occur, how we were going to decrease the hospital census to deal with potential overflow, methods of securing the campus, and the latest police updates.

On Friday afternoon I summed up our discussions with my …

Doctors don’t have the luxury of grief

Jenna T. Nakagawa, MD, MPH

Physician

August 13, 2017

On a normal Tuesday, one of my fellow residents did the same things we all do. She woke up before sunrise, put her best face forward, came to work, saw patients quickly, wrote notes, said “good morning” to everyone at morning conference, saw more patients, wrote more notes, then went home. She said “good night” to her loved ones — her parents and siblings at home — and went to …

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Doctors don’t have the luxury of grief

12 tips for giving patients bad news

Rabbi Chaya Gusfield, BCC

Conditions and Diseases

August 13, 2017

My partner Judith had pain in her sinus cavity caused by a tumor called a plasmacytoma. After her biopsy, her surgeon called Friday afternoon with the results. She asked him to wait fifteen minutes until I could be home with her to get the news. He had no flexibility and said he could speak either then or Monday. She chose to speak with him then on the phone still alone. …

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12 tips for giving patients bad news

How to unite doctors in these divided times

Matthew Hahn, MD

Health Policy

August 12, 2017

American doctors are unhappy about a lot of things. Americans, in general, are unhappy about a lot of things. In many ways, both groups share similar concerns. But the road back to happiness may follow a similar path for both, as well.

American doctors once felt part of something special. American health care, by reputation at least, was the best in the world, and we were its proud emissaries. We functioned …

How this physician lives his life in the margins

Jeffrey McWilliams, MD

Physician

August 11, 2017

Do you ever have that “aha!” moment? That moment when a revelation hits you with such a level of intensity that your physical being is jolted. Attention is obtained as if a Louisville slugger or defibrillator pad made contact at an opportune moment. That moment of revelation when a crimson string interwoven through the fabric of your life makes a connection, transcending childhood, college, young adulthood, professional and personal relationships. …

As a physician, you will fail at your job in these different ways. Learn from them.

Binh Phung, DO

Physician

August 11, 2017

To me, five years ago:

Right now you are 28, seated at the top of everything: chief resident of the entire pediatric department. You are in charge of 19 other interns and residents. You are resilient, kind, funny and determined. You seem to have the solution for everything, yet you don’t actually have the answer to anything. At least that’s how you’ll feel on most days in your new leadership role. …

Here’s why this doctor came around to single-payer insurance

Giri Venkatraman, MD, MBA

Health Policy

August 11, 2017

The two biggest sources of frustration for the majority of physicians are the EMR systems and bureaucracy within the work environment that physicians are forced to deal with daily. EMRs are a ship that has sailed, unfortunately, and our only option currently is to try and improve this situation.

However, the bureaucracy and administrative burdens that physicians encounter are issues that we should challenge, and I feel single payer is a …

3 ways health IT impedes communication

Suneel Dhand, MD

Health Technology

August 10, 2017

As many of you know, much of my focus has been on how we can improve health care information technology, and build on the systems that we currently have to make them more user-friendly and less cumbersome. At the crux of the problem is the issue of the disproportionate amount of time they take to navigate and how they turn the noble and personable art of being a doctor, into …

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3 ways health IT impedes communication

Should only infectious disease specialists be allowed to prescribe antibiotics?

Craig Bowron, MD

Medications

August 9, 2017

The WHO’s recent announcement of multi-drug resistant strains of gonorrhea raises the specter of a worldwide SuperClap Attack that even the Avengers couldn’t foil. It also comes as yet another ominous reminder of the perils of rampant and indiscriminate antibiotic use.

There’s plenty of blame to spread around. True, here in the U.S., consumers can’t buy antibiotics over the counter, but that hasn’t kept physicians and other providers from over-prescribing them …

A hospital leader speaks out against the transgender military ban

Suzanne Koven, MD

Physician

August 9, 2017

On the afternoon of July 26, I opened an email from Dr. Peter Slavin, president of Massachusetts General Hospital, where I work as a primary care doctor. Dr. Slavin frequently sends messages to all MGH employees, uncontroversial broadsides announcing new hospital initiatives, grant awards, promotions and retirements that often end with: “Go Sox!” (or, depending on the season, “Patriots!” “Celtics!” “Bruins!”).

So I was not expecting that …

The sad direction of hospital care

Steven Reznick, MD

Physician

August 8, 2017

My 74-year old obese, poorly controlled diabetic patient with high blood pressure, high cholesterol, coronary artery disease, asthma, obstructive sleep apnea has been difficult to motivate to improve his lifestyle and his health. He is bright, sweet and caring but just not very disciplined.

At each office visit, we review his medications, review his dietary habits and go through the check list of check-ups for diabetic complications including regular ophthalmology exams …

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The sad direction of hospital care

Make the patient feel like the absolute center of your world

Suneel Dhand, MD

Physician

August 6, 2017

Several years ago, when I was working as a hospital physician in Florida, a patient’s wife said something that has always stuck with me. The service was very busy on that day, and I was doing my best to get through everybody in a timely manner. I was with a patient whose wife was at the bedside, beside herself with worry. I was focused on the main presenting complaint, but …

Stop piling on physicians: The last straw in burnout

Paul DeChant, MD, MBA

Physician

August 6, 2017

We are all familiar with the saying: “the last straw.” It refers to the fable of the camel who could carry heavy loads.

In the story, the camel is a beast of burden. Its owner, in an effort to transport as much straw as possible, keeps piling more and more on the camel’s back. Camels are strong and can handle a lot. But at some point, even the strongest camel will …

Inappropriate patient behavior is not OK

Sanghamitra Sadhu, MD

Physician

August 4, 2017

“OK, one more patient to go,” I said to myself with my eyes quickly scanning the patient list in my hands. I was in the elevator, going up the spanking new glass tower in the giant tertiary care hospital I call my workplace. Today was turning out to be a better Monday than usual. I had worked over the weekend, so I knew the patients. And there were no major …

Here’s how being a parent changes you as a physician

Sehyr Imran, MD

Physician

August 4, 2017

I sit in my living room at the end of a long day. I open my laptop to complete the day’s clinic notes. I look up to see my daughter busy painting (she’s two years old, so less than half the paint is going on the coloring book and most is being smeared over her hands and feet). I hear the distant clatter of dishes as my husband loads the …

3 reasons why July 1st should be a day to celebrate

N. Bande Virgil, MD

Medical Education

August 4, 2017

Fireworks, champagne toasts, sparkly hats, and the ball drop are all items that we conger up in our minds as we think of the New Year. For the majority of the world, January 1st represents the transition from one year to another on the calendar. New resolutions are made, and there is a global fresh start. However, for those of us in the medical field, there is another new year …

5 communication mistakes physicians should avoid

Suneel Dhand, MD

Physician

August 1, 2017

Being a doctor is about as much of a social job as one can get. Even though computers and healthcare information technology mean that physicians are now spending a disproportionately large amount of their time staring at their computer screens, there’s no getting around the importance of good old face-to-face interactions. That’s also what’s valued by your patients. In this time of great upheaval in healthcare, everything has …

Hospital Medicine

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